11例食管平滑肌瘤临床病理X线分析

本文对11例食管平肌瘤的临床病理X线表现进行分析,本病临床症状轻微,具有典型粘膜下良性肿瘤膨胀性生长的病理特征,X线检查能充分反映其病理基础．除边线光滑的腔内充盈缺损或范围一致的腔内外肿块、“环形征”、粘膜不同程度挤压等固有X线特征外,作者认为“扇形增宽皱襞”、“肿瘤移动征”等特异征象,对诊断也很有帮助．术前诊断主要依靠食管钡餐检查．文中并讨论了鉴别诊断．     

食管异物摘取术的麻醉选择

为探讨食管异物摘取术的麻醉方法，提高手术效果，对７２例食管异物患者采用强化表面麻醉法和气管内插管麻醉法进行了手术和对比观察。７２例异物均取出顺利，无严重并发症发生。资料显示：两种麻醉各具优越性，前者适用于年龄较大的儿童和成人，后者适用于食管异物并呼吸困难的小儿。     

In Vitro and In Vivo Effects of Nonsteroidal Anti-inflammatory Drugs and Aspirin on Rabbit Esophageal Epithelium

BackgroundGastroesophageal reflux disease has a high incidence of 23%, with 29% of those with gastroesophageal reflux disease consuming nonsteroidal anti-inflammatory drugs. There are insufficient data concerning the effects of nonsteroidal anti-inflammatory drugs on the esophageal tissue. We aimed to examine the effects of well-known nonsteroidal anti-inflammatory drugs using electrophysiologic criteria on the rabbit esophageal epithelium.MethodsEsophageal epithelium mounted on Ussing chambers enabled in vitro investigation of the electrophysiological properties. Doses of 1 mg/mL, 2.5 mg/mL, 5 mg/mL ibuprofen, naproxen, and aspirin were dissolved in dimethyl sulfoxide and added to the luminal side. Esophagi were cannulated from both sides for the administration of high-dose ibuprofen in vivo, and the potential difference was monitored.ResultsIbuprofen and aspirin inhibited tissue transport functions in a dose-dependent manner. pH 4 acid and 0.1 mg/mL ibuprofen alone were not harmful; however, the combination of these agents had an additive and significance effect: 78% decrease in the potential difference and 85% decrease in the short-circuited current (Isc). The change in the potential difference in the in vivo experiments (5 mg/mL ibuprofen) was similar (52 ± 7% decrease) with in vitro experiments in the first 30 minutes.ConclusionNonsteroidal anti-inflammatory drugs were harmful to the rabbit esophageal epithelium in both the in vitro and in vivo experiments. Even though aspirin and ibuprofen affected the transport mechanisms of the esophageal epithelium, the dose-dependent decrease of tissue potential difference and Isc with ibuprofen was more pronounced than those with aspirin. The combination of harmless doses of ibuprofen and acid demonstrated that even low acidic conditions can create a disruptive environment.     

The effects of oral steroid duration on stricture prevention after extensive endoscopic submucosal dissection for superficial esophageal cancer

BackgroundEsophageal stricture is a major complication of endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer (SEC). Oral steroids have been used to prevent esophageal stricture in patients with more than 75% of the esophageal circumference resected. However, there are no established guidelines regarding the optimal duration of steroid use. This retrospective observational study aimed to compare the incidence of esophageal stricture according to the period of prophylactic oral steroid use and to identify the risk factors for esophageal stricture.MethodsEighty-one patients who were prescribed prophylactic steroid after undergoing ESD for SEC with more than 75% of esophageal circumference resected were enrolled. Patients were classified into the four-week steroid group (n=72) or eight-week steroid group (n=9) to compare the incidence of esophageal stricture. In addition, the patients were subdivided into those who developed esophageal stricture (n=24) and those who did not (n=57) to identify the risk factors for esophageal stricture.ResultsTwenty patients (27.8%) in the four-week oral steroid group and four patients (44.4%) in the eight-week oral steroid group developed esophageal stricture (P=0.44). The univariable analysis identified tumor size, longitudinal length of semi-circumferential resection, and proportion of circumferential resection as risk factors of esophageal stricture. The multivariable analysis identified the proportion of circumferential resection as an independent risk factor. After adjusting for the proportion of circumferential resection, the incidence of stricture was marginally higher in the eight-week steroid group [P=0.05; odds ratio (OR): 5.69; 95% confidence interval (CI): 1.01–32.15].ConclusionsEight weeks of oral steroid prophylaxis does not reduce the risk of stricture after extensive ESD more than four weeks of oral steroid prophylaxis. The proportion of circumferential resection is the strongest risk factor for stricture in patients with SEC undergoing ESD.     

华蟾素配合立体定向放射治疗中晚期食管癌28例

目的观察华蟾素配合立体定向伽玛射线放射治疗中晚期食管癌的近期临床疗效。方法将56例患者随机均分为华蟾素联合伽玛刀治疗组（治疗组）和伽玛刀单独治疗组（对照组）。伽玛刀治疗总剂量40～50Gy,次数10～12次,边缘剂量300～420cGy,等剂量曲线55%～85%,每日治疗1次;治疗组加用华蟾素注射液20～30mL静脉滴注,1次/d,连续3～4周。结果 56例患者均顺利完成治疗,治疗组梗阻症状总缓解率、影像学总缓解率均显著高于对照组（P均小于0.05）;治疗组不良反应如急性放射性食管炎、白细胞下降发生率虽低于对照组,但差异无统计学意义（P〉0.05）。结论华蟾素注射液联合伽玛射线立体定向放射治疗中晚期食管癌患者,临床症状缓解率高,毒副作用小,患者耐受性好,近期疗效令人满意。     

新生儿鼻咽部错构瘤脱落至食管上段1例

患儿,男,以“发现口腔内新生物4h”为主诉就诊。该患儿为38周足月剖宫产,羊水、胎盘、脐带正常,于当地医院出生后清理口腔时发现一新生物,因未及时牵引出,新生物脱落向下,具体部位不详,患儿呼吸音粗,无明显呼吸困难、憋气症状。     

138例食管胃结合部肿瘤病例分析

目的：通过分析138例食管胃结合部肿瘤的临床病理特征、手术方式,探讨食管胃结合部肿瘤不同Siewert分型和手术方式对预后的影响。方法：回顾性分析洛阳市中心医院2000年-2006年食管胃结合部肿瘤138例手术病例的临床病理特征及手术方式,将138例病例参照Siewert分类方法进行分类,分析不同Siewert分型和手术方式对预后的影响。结果：138例中AEGⅠ型10例,AEGⅡ型20例,AEGⅢ型108例,三种类型AEG预后存在明显差别,不同手术方式的5年生存率明显不同,脾切除的患者生存时间无明显改善,并发症增加。结论：三种类型的AEG预后不同,选择不同手术方式其5年生存率亦不同,根据AEG分型选择适当手术方式可以改善预后;脾脏切除并不能改善患者预后,保留脾脏的淋巴结清扫是可行的,但要确保做到肿瘤的根治切除和严格的淋巴结清扫。     

食管癌、贲门癌术后呼吸功能不全高危因素分析

目的:探讨食管癌和贲门癌术后发生呼吸功能不全的高危因素。方法:采用回顾性病例对照研究,应用Logistic回归分析食管癌和贲门癌术后呼吸功能不全发生的高危因素。结果:经Logistic回归分析,术后发生呼吸功能不全的高危因素按相关强度依次为:术前合并COPD、手术时间长、高龄、手术日输液量多。结论:术前合并COPD(chronic obstructive pulmonary disease)、手术时间长、高龄是食管癌术后发生呼吸功能不全的高危因素;严格手术适应证,术者的丰富经验及娴熟技术,积极围手术期处理是防治术后呼吸功能不全的有效措施。     

左旋咪唑对MANA诱发大鼠食管癌前病变及免疫功能影响

目的本文旨在探讨左旋咪唑预防食管癌的作用及与免疫的关系。方法Ｗｉｓｔａｒ大鼠９０只,随机分为三组,分别给左旋咪唑、太洛龙（阳性对照）、生理盐水（阴性对照）,用甲基戊基亚硝胺ＭＡＮＡ诱发食管癌前病变,经１０５天实验后,检测食管癌前病变发生率,并测定免疫器官指数,外周血Ｔ淋巴细胞和自然杀伤细胞（ＮＫ细胞）。结果显示左旋咪唑降低食管癌前病变发生率的作用和太洛龙（Ｔｉｌ）相似,并使外周血Ｔ淋巴细胞和ＮＫ细胞明显增加。Ｔｉｌ组ＮＫ细胞无增加。结论左旋咪唑和太洛龙具有相似地预防亚硝胺诱发食管癌作用,并与增强机体免疫功能相关。     

食管、贲门癌患者手术前后血清铜蓝蛋白含量变化的研究

本文用放射免疫分析法测定了４５例食管、贲门癌患者手术前后血清铜蓝蛋白（ＳＣＰ）含量的变化，并与４４例正常人进行对照。结果表明：食管、贲门癌病人手术前后均显著高于对照组（Ｐ＜０．０１）；手术后病人ＳＣＰ呈递减趋势，７２ｈ后ＳＣＰ开始明显下降，与手术前对照（Ｐ＜０．０５）。并观察到术后有转移的患者ＳＣＰ持续保持高水平。病情稳定者，ＳＣＰ趋于正常。由此认为：ＳＣＰ可以作为食管、贲门癌的诊断、判断预后、有否转移和复发的一项重要辅助参考指标。